• Thanh Tat Nguyen, Nhung Thi-Hong Le, Ngoc Minh Nguyen, Viet Chau Do, Tung Huu Trinh, and Luan Thanh Vo.
• Department of Infectious Diseases, Children's Hospital No.2, Ho Chi Minh City, Vietnam.
• Medicine (Baltimore). 2022 Oct 28; 101 (43): e31322e31322.

RationaleDengue obstructive shock syndrome is a fatal complication commonly observed in the late critical phase of dengue infection and is associated with a high mortality rate. The main pathogenesis involves a dramatic increase in chest pressure, owing to severe plasma leakage and mechanical respiratory support, hampering the heart's ability to pump effectively and impeding adequate blood venous return to the heart chambers. To date, there is a paucity of clinical data about Dengue obstructive shock syndrome reported.Patient ConcernsThe 2 reported patients presented with prolonged and decompensated dengue shock with critical multi-organ failures and mechanical ventilation. The patients' hemodynamics were profoundly affected by high pressure in the thoracic and abdominal cavities resulting from Dengue-induced severe plasma leakage and mechanical ventilation.DiagnosesClinical presentations, laboratory data, mini-fluid challenge test, and point-of-care (POCUS) were used to make diagnoses and guide management.InterventionsClinical monitoring, judicious fluid (colloids and blood products) administration guided by repeated POCUS to properly assess the adequacy of the intravascular volume, homeostasis adjustments by plasma exchange, and continuous renal replacement therapies.OutcomesThe patients had favorable outcomes.LessonsOur study highlights the clinical manifestations and management of children with dengue obstructive shock syndrome and underscores the importance of monitoring hemodynamics by consecutive POCUS at the bedside in order to make a timely diagnosis and assess intravascular fluid volume inadequacy accurately as well as closely monitor the fluid management responses.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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